I had a blockage in my bile duct last spring and they did an ERCP and snipped it. (They had no idea what caused it and said I should have no further problems.) Then last week I was so sick I had to go to the ER with severe stomach pains, bloating, nausea, vomiting. They did some blood work and my Lipase and White counts were up and so they did a CT with iodine and said there was something there but they weren't sure what so they admitted me and did an ultrasound. They said that my bile duct was enlarged which they said it was last time and it would never be normal. They said my Lipase returned to normal so they didn't think that could be a problem since it lowered so quickly. I ran a low grade fever and had diarrhea but they said the diarrhea was probably from the iodine. I have been on a soft diet for about six days and just eating a little bit as I still have abdominal pain and the idea of food is not too appealing. I could not go through another night of pain like I just had. Last spring I basically stopped eating and just drank apple juice and chicken bullion for several weeks because of the sharp pain. It seems somewhat similar this time. The doctors just basically said they don't think I have cancer or that would have showed up and to just go home. Any suggestions? Do I insist on having another ERCP and can I do that several times a year forever?
Your second time symptoms were very probably due to another blockage into bile duct or in a part where hepatobiliary duct and pancreatic duct join. What speaks for this: elevated lipase and white cells, which indicate transitient inflammation of pancreas, due to that blockage. This is only one possibility, though.
Blockage could be due to biliary stones (or even a dense bile - biliary sludge, which may not be always detected by ultrasound). In the case of cancer, the duct wouldn't be released just like that, I think.
So, possible reasons are:
1. a stone or sludge in gallbladder, in bile duct or in common hepatobiliary-pancreatic duct, (or inflammation, but less likely cancer). Diagnosis is with HIDA scan. they inject a contrast substance into a vein, and then take images, as this substance is flowing through your gallbladder and bile duct. It can show blockage, just like ERCP, only you don't need gastroscopy.
The problem with ERCP is, that, if a stone was lodged in the duct and then released, nothing will be seen on ERCP.
2. a stone or dense secretion from pancreas (less likely)
Thanks so much for your helpful comments. The comments about what the lipase and white cells mean was something I was really looking for. They do not think it is a stone because they did a HIDA scan last spring and said there was no stone - which is what they were expecting. If it is not a stone or cancer and I have not had previous surgery there seems to be no answer. My doctor seems to be fine with the fact that I have an enlarged bile duct, but I think it is beginning to be obstructed again. I must decide whether to insist on another ERCP which I understand is not so great to have because of possible side effects. (I ended up in the hospital for acute gas pains after the last one.) Or do I try to find another doctor and then I have no clue where to go to find a doctor who would do any other than what my doctor has done.
Maybe you can just ask for second opinion (on the basis of investigation and images you already have)
So, you can ask:
- is that enlarged bile duct, enlarged just like that, or is it possibly something within it (and not seen clearly with ultrasound or HIDA).
- last spring is...far away. HIDA is much easier test than ERCP, you can ask, if there is any point in repeating it. I mean, you once had blockage, it's just possible to have it again. Bile sludge (dense bile but not enough dense to form stones) may also cause blockage. This bile sludge may be easily overlooked.
I have had simular syptoms,I have had 6or 7 ERCP's.I am no better.I just keep going to ER,it is just awful.I now have had 3 doctors write me,one even being from a transplant dept.they all said it could possibly be cholangitis and I need a liver biopsy.they all said that cholecystitis are misdiagnosed sometimes when in reality it is cholangitis.You can email me at ***@**** if you want to.I am not very good at running this computer so hopfully I can figure out how to get back to you.
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